Periodontal disease is a common problem affecting many Americans today. Earliest indication of periodontal disease in change in bone and tissue mass. Both assessment of bone support and the detection and measurement of small changes in bone and soft tissues are fundamental tot he intraoral examination. The need for improved image resolution with minimal patient exposure has long been recognized. In conventional X-ray detection media, such as thick phosphors and film screens, there exists a problematic tradeoff between the increasing thickness and decreasing spatial resolution due to lateral light spreading. Current X-ray sensors therefore limit the effectiveness of many radiographic procedures and necessitate unduly high patient exposure. To address this situation, we propose to develop a novel imaging sensor based on a structured CsI scintillating plate coupled to a large area charge-coupled device (CCD). This microstructures plate consists of micron-sized columnar crystal structures which prevent lateral spreading of the scintillation light through the process o total internal reflection. For detecting dental X-rays with high resolution, the proposed concepts allows a high detection efficiency without sacrificing image quality. A large area, novel scintillation plate coupled to a suitable large-are CCD will exhibit 99% detection efficiency, excellent dynamic range, and high spatial resolution. These are desirable properties for high contrast intraoral imaging procedures such as digital subtraction radiography for accessing small progressive alveolar bone loss.